Provider Demographics
NPI:1275254153
Name:EDGLEY, HOLLI (FNP-C)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:
Last Name:EDGLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CORNELIA ST STE 306
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2789
Mailing Address - Country:US
Mailing Address - Phone:518-566-9452
Mailing Address - Fax:
Practice Address - Street 1:206 CORNELIA ST STE 306
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2789
Practice Address - Country:US
Practice Address - Phone:518-566-9452
Practice Address - Fax:518-562-7189
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF350132-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily